Compelling commentary on children's health

It’s always been in breast milk, then it appeared in infant
formula and now you can find it in baby food.It’s DHA (docosahexaenoic acid).So what
is DHA and do you need to be feeding your baby DHA-supplemented baby food?

What is DHA? DHA
is a special fatty acid critical to brain and eye development in babies and
young children.Babies get a bunch
of it during the last trimester of gestation and then become dependent upon
getting DHA in their diets.DHA is
found in breast milk (as it turns out, levels in breast milk depend upon your
diet) and it first was added to infant formula here in the U.S. in 2002.

What does it do?Studies have shown that DHA, when added
to a baby’s diet at certain levels, can improve brain development and vision.While this was initially felt to be
true only in preemies, recent studies have supported a neurodevelopmental role
for DHA in term babies.And if
that is isn’t interesting enough, try this on for size: A new study released
this summer (abstract findings presented at the World Congress of Pediatric Gastroenterology, Hepatology and Nutrition) found a tight connection between DHA exposure in infancy and
resistance from upper respiratory infections later in childhood.Wow.While its suspected that the effects reported in this study
may be seen with the levels of DHA found in Mead Johnson’s Enfamil Lipil or
Nestle Good Start, the study was conducted among children fed Enfamil Lipil.

Here’s the problem. When it comes to brain and eye
development, no one knows exactly how much DHA a baby needs.Several organizations have taken a stab
at minimums but they’re nothing better than a stab.And these stabs are based on minimum levels proven
to make a difference.The American
Dietetic Association, for example, has suggested that infant formula contain at least 0.2%
of its fatty acid content as DHA.The American Academy of Pediatrics has been conspicuously silent on DHA
since its introduction into infant formula.

So back to our
question.Do children need DHA
in their baby food? No one knows
the answer to this question.While
we may accept the mounting data showing that certain levels in infant formula when taken at standard baby volumes are associated with improved brain development and vision, there’s no evidence that
the addition of more DHA in baby food offers any advantage.

But as with most elements of our baby’s diet,
the body takes what it needs and what remains feeds the Diaper Genie.And so it may be with DHA.But at least we all feel good believing
we’ve tried to make a difference.

So it’s looking like the great U.S. melamine scare of 2008
has appropriately turned out to be a big nothing.If you missed it, the FDA reported small amounts of melamine
in all three of the major formula manufacturers here in the U.S.And if you’ve really had your head in
the sand, melamine is the stuff that Chinese milk suppliers were using to
create the appearance that their milk was better than it was.The result was 50,000 babies with
kidney stones and a few deaths.

So it was true that the FDA found trace amounts of melamine
in U.S. formula but at levels that are barely detectable.To illustrate, this is the equivalent
of one drop of melamine in 64 gallons of infant formula.Or 10,000 times of that seen in the
China scandal.But there’s no
scandal here.As it turns out the
miniscule levels found here were the result of a solution used to clean
manufacturing equipment.Not an
excuse by any means but certainly an explanation that doesn’t suggest scandal
or appreciable risk.This is a
bigger PR problem than a medical problem.

So should parents switch formulas?As an industry-wide finding this wouldn’t appear to make any
sense.Sit tight and recognize
that in the scheme of environmental exposures to lose sleep over, this ranks
twenty or thirty on my list of parental worries.

Should I breast feed?Of course you should breast feed.But not everyone can breast feed and not everyone breastfeeds forever.I’m not able to find any studies on
Pubmed that have evaluated melamine transmission in breast milk.Remember that when it comes to
environmental substances, breast milk isn’t always the solution we wish it
were.What mom gets baby often
gets.Think bisphenol-A,
unfortunately.

While the formula industry has been conspicuously silent on
the issue, I haven’t.You can see
me on Houston’s Fox News Channelhere.

Everybody has reflux.But not everybody is sick with reflux.And so it goes for babies.Spits, urps and wet burps, the sin qua non of reflux, are
what we expect in healthy, normal babies.But are there other signs to suggest that your baby has more than a
simple case of the spits?You
bet.Here are 5 common signs of
reflux in babies that parents often witness but don’t associate with reflux:

1.Irritability.Tummy
contents are quite acidic and create painful irritation when washed over the swallowing tube and throat.Look for pain after eating and when
lying down.The irritability
associated with reflux also causes baby to arch more than crunch.

2.Congestion.If refluxed
tummy contents reach the throat it creates a slight degree of swelling and
irritation.The result is noisy,
congested breathing often mistaken for allergy or cold.Think of reflux when congestion is
persistent and associated with other signs of reflux.

3.Sleep
disturbance.When it comes to
reflux, gravity is king.And recumbency
may make it more apparent.While a
baby may not have dramatic symptoms during waking hours, the horizontal baby
may show her true colors.Look for
acute, “pin-in-the-foot” awakening, unsettled sleep.

4.Difficulty
feeding.Sometimes feeding
difficulty is the only sign that a baby is suffering with acid-related
pain.Esophagus (swallowing tube)
irritation classically makes babies pull back and fight the breast or bottle
resulting in feeding sessions painfully long for mom and baby.I’ve referred to this pattern as
indecisive or chaotic feeding.

5.Gas.Yes, gas.As it turns out, the indecisive feeding described in #4
above frequently leads to big air swallowing.And what goes down must come out.I frequently evaluate babies with debilitating gas where the
inciting problem is actually chaotic feeding from reflux.Who knew?

For more colorful details of the above symptoms, pick up a
copy of Colic Solved – The Essential
Guide to Infant Reflux and the Care of Your Screaming, Difficult-to-Soothe Baby (2007 Ballantine).

Last month the Food and Drug Administration reported that
small amounts of BPA are not dangerous. But last week the National Toxicology Program, the federal agency for
toxicological research, confirmed “some concern” about the effects of BPA in
the brains of fetuses and small children.Many media outlets favored the FDA’s verdict and declared,“All clear – it’s safe to feed – sorry
about any confusion.”The New York
Times, however, stood on its own this weekend and raised questions about the
federal mixed message.

The evidence suggesting that BPA exposure may affect early
neurodevelopment is compelling.I
have read the NTP’s findings and explored some of the original literature on
the subject.The question that
remains unanswered is:How much is
safe?The FDA has suggested that
the level of exposure in the typical baby isn’t a concern.The NTP isn’t so sure.Irrespective of Uncle Sam’s indecisiveness, it would appear as though
the American marketplace is sorting this issue out on its own.Infant product lines in the States are
evolving to meet the wishes of parents who are holding a referendum with their
pocket books.

While there have been pockets of hysteria in the BPA
dialogue, I am suggesting that parents minimize BPA exposure on a going forward
basis.Since the primary route of
exposure is ingestion, I recommend BPA-free for anything that your child will
bite, chew, eat or drink from on a regular basis.If you must use a BPA containing product, avoid intense heat
exposure through microwaving.

And as far as more practical guidance from the feds, I'll let you know if I hear anything...

Some interesting Labor Day stats: According to Airfarewatchdog, 85% of surveyed readers believe that airline carriers should dedicate sections for parents of babies and young children. And 100% suggested that they would pay a premium to fly without the patter of little feet in the aisle.

While I’m inclined to think that this reflects the worst of society, traveling with children is admittedly difficult for everyone involved. And the stress of close quarters is only compounded in the presence of a toddler with ears that won’t decompress.

As a dad traveling with children I have never traveled with a sense of entitlement. Yes, I paid as much as the man trying to sleep in the seat in front of us. But he has no obligation to embrace my daughter’s occasional outburst or need for a diaper change. As traveling parents all we can do is plan ahead, pray for sleep and count each minute to landing.

When I coined milk protein allergy in babies as “the other colic” (title of chapter 5 in Colic Solved) I never thought it would grace the pages of The Wall Street Journal. Last week’s reflux piece makes an encore in today’s health mailbox.

Melinda Beck penned a nice piece on the reflux-colic debate in today’s Wall Street Journal. The article, Baby Crying? Doctors Say It May Be Acid-Reflux Disease, is nicely balanced and catches the clear and present trend that the concept of colic is finally approaching DNR status.

Favorite quote: The suggestion by Dr. Vikram Khoshoo that as a doctor the purpose served by the treatment of acid reflux in a baby is to get mothers off your back (note to self: reassess West Lafayette, Lousiana as a leading center of thought in medicine). And there's lots of good press for Beth Pulsifer-Anderson and PAGER (Pediatric/Adolescent Gastroesophageal Reflux Association) who are always working to legitimize screaming babies.

You’ll find me, the pediatrician desperately pulling up the rear, with the contrarian view that babies who scream deserve real attention. While The Wall Street Journal identifies my daughter Laura as the source of my reflux epiphany, I have to admit that the success of treating thousands of babies misdiagnosed as colic perhaps represents my greatest influence.

I don’t see this every day: a major publication devoting significant space to tell parents precisely why children need vaccinations. Reference Parents Magazine and their July 2008 feature, Why Babies Need Shots. Their interview with Dr. Ari Brown also offers real answers to real questions. Refreshing really when you consider how often the main stream media supports the loud voice of a misinformed anti-vaccine minority peddling fear and conspiracy theories.

Hats off to Parents Magazine for using their valuable platform to help advocate for children.

Maryland’s Howard County Health Department has taken the step of providing only bisphenol A-free products to its WIC (Woman’s, Infants and Children) Program. WIC provides supplies and supplemental foods to low-income pregnant women, new mothers, infants and children under the age of 5. According to Maryland Med, Dr. Peter Beilensen, Howard County’s top health official “hopes to turn BPA into another trans fat: legal but largely shunned by the public.”

As far as I can tell this is one of the first WIC programs in the country to take a firm stand on BPA. But here’s the $64,000 question: Will the Howard County Department of Health restrict infant formulas packaged in BPA lined containers? And if you’re going to be BPA-free, how free do you need to be?

While I respect Dr. Beilensen’s stand on the issue, his department’s broad statement on BPA is as likely to fuel public hysteria as it is to positively influence the indigent children of Howard County. And while I agree with their policy as it pertains to bottles, their commitment to go BPA-free will need to address the issue of when, where and how much is too much (aka, the packaging issue) as well as the real risk of non-oral exposure. And he will inevitably need to explain to the citizens of Howard County that there are more questions to be answered before public health policy can be chiseled in stone.

Here are the facts: babies go through a very transient period where their production of lactase (the bowel enzyme necessary for digestion of lactose) is subpar. Beyond this very early and temporary period, babies tolerate lactose just fine. There are a handful of babies in recorded medical history who have been born without lactase. And unless you’ve birthed one of these half-dozen babies, your baby shouldn’t need a lactose-free formula. One exception: viruses may injure the lining of the small bowel to the point where lactase can be temporarily lost. While some pediatricians will recommend going lactose-free during this time period, there’s little evidence that it actually improves a baby’s course of diarrhea. And soy formulas for generations have covered the waterfront just fine – they’re lactose-free.

And while there will always be those who claim that lactose-free formula “saved their baby’s life”, there will also be those who suggest that switching from Similac to Enfamil had the same impact. Infant formula urban legends are complicated and what some parents report is truly hard to reconcile. I can say this as a father and a pediatrician.

As someone who makes a living caring for babies with fragile tummies, I can attest to the fact that presence of lactose-free formula on grocery store shelves serves to confuse parents. And in some cases this confusion fuels the game of formula roulette. While I won’t go so far as to call the marketing of lactose-free formula irresponsible, I will suggest that it should go the way of low-iron formula. It represents a market-driven product that doesn’t serve the needs of its customer, the baby. Further, its empty promise of soothing “colic” serves only to bamboozle desperate parents who think that it might make a difference.